https://ogma.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:52943 Wed 28 Feb 2024 16:14:20 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:6972 Wed 11 Apr 2018 15:26:57 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:34541 Wed 09 Mar 2022 16:02:40 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:8092 Sat 24 Mar 2018 08:34:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:15698 Sat 24 Mar 2018 08:22:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:18973 Sat 24 Mar 2018 07:58:53 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21364 11 mmol/L). We also recorded swallow screening and assessment during the first 24 h of admission. Results: Data for 718 (98%) patients were available; 138 (19%) had four hourly or more temperature readings and 204 patients (29%) had a fever, with 44 (22%) receiving paracetamol. A quarter of patients (n = 102/412, 25%) had six hourly or more glucose readings and 23% (95/412) had hyperglycemia, with 31% (29/95) of these treated with insulin. The majority of patients received a swallow assessment (n = 562, 78%) by a speech pathologist in the first instance rather than a swallow screen by a nonspeech pathologist (n = 156, 22%). Of those who passed a screen (n = 108 of 156, 69%), 68% (n = 73) were reassessed by a speech pathologist and 97% (n = 71) were reconfirmed to be able to swallow safely. Conclusions: Our results showed that acute stroke patients were: undermonitored and undertreated for fever and hyperglycemia; and underscreened for swallowing dysfunction and unnecessarily reassessed by a speech pathologist, indicating the need for urgent behavior change.]]> Sat 24 Mar 2018 07:51:25 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:27416 Sat 24 Mar 2018 07:35:25 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:28777 11 mmol/l), and swallowing dysfunction in intervention stroke units. Results: Data from 1804 patients (718 preintervention; 1086 postintervention) showed that significantly more patients admitted to hospitals allocated to the intervention group received care according to the fever (n = 186 of 603, 31% vs. n = 74 of 483, 15%, P < 0·001), hyperglycemia (n = 22 of 603, 3·7% vs. n = 3 of 483, 0·6%, P = 0·01), and swallowing dysfunction protocols (n = 241 of 603, 40% vs. n = 19 of 483, 4·0%, P ≤ 0·001). Significantly more patients in these intervention stroke units received four-hourly temperature monitoring (n = 222 of 603, 37% vs. n = 90 of 483, 19%, P < 0·001) and six-hourly glucose monitoring (194 of 603, 32% vs. 46 of 483, 9·5%, P < 0·001) within 72 hours of admission to a stroke unit, and a swallowing screen (242 of 522, 46% vs. 24 of 350, 6·8%, P ≤ 0·0001) within the first 24 hours of admission to hospital. There was no difference between the groups in the treatment of patients with fever with paracetamol (22 of 105, 21% vs. 38 of 131, 29%, P = 0·78) or their hyperglycemia with insulin (40 of 100, 40% vs. 17 of 57, 30%, P = 0·49). Interpretation Our intervention resulted in better protocol adherence in intervention stroke units, which explains our main trial findings of improved patient 90-day outcomes. Although monitoring practices significantly improved, there was no difference between the groups in the treatment of fever and hyperglycemia following acute stroke. A significant link between improved treatment practices and improved outcomes would have explained further the success of our intervention, and we are still unable to explain definitively the large improvements in death and dependency found in the main trial results. One potential explanation is that improved monitoring may have led to better overall surveillance of deteriorating patients and faster initiation of treatments not measured as part of the main trial.]]> Sat 24 Mar 2018 07:23:45 AEDT ]]>